Purpose

Because publicly-funded, community-based physical therapy (PT) services
through Ontario’s network of Schedule 5 providers were partially delisted
in April 2005, we examined the perceived consequences of this policy decision
among different provider categories following partial delisting. Schedule
5 providers or clinics, renamed “Designated Physiotherapy Clinics” following
partial delisting, are privately-owned and operated facilities that have
agreements with Ontario’s Ministry of Health and Long-Term Care to
deliver publicly funded services for eligible clients.

Methods

A health policy research approach used semi-structured telephone interviews
with 33 physical therapists from Schedule 5 clinics, home care
settings, hospitals, and private clinics within the Greater Toronto Area
and across Ontario.

This study is part of a larger health policy research project that examined
the consequences of partial delisting of PT services in Ontario
for clients and providers. In keeping with health policy research,
this study used a multimethod approach that included interviews
with PT providers in a variety of settings two weeks prior to and two
weeks after partial delisting.

Results

Schedule 5 providers perceived an immediate decrease in demand, whereas
PT providers from other categories reported no change at the time
of interview. Conversely, all providers forecasted decreased access
for ineligible clients but a potential for improved access and
reduced wait times among those who remained eligible. In the final analysis,
PT informants in all categories agreed that partial delisting was
an improved policy decision compared with full delisting, as proposed initially.

All informants felt that, in time, there would be a significant decrease
in access for clients. They also reported potential detrimental effects
for clients between the ages of 20 and 64 years and those without private
health insurance. All informants, irrespective of provider category,
expressed general concern that prior to delisting, “the people
who were accessing the Schedule 5 services were people [who] probably
couldn’t afford it and didn’t have [private insurance] coverage.” Many
informants were concerned that clients who could not pay out-of-pocket
for services would not continue treatment elsewhere. The Schedule 5 providers
reported that this was already happening. As one said: “…none
of those patients have since come back… I know there are people
out there who could be using one-on-one therapy with a registered physiotherapist
who have chosen not to because they have to pay for it. So there is definitely
an impact of the partial delisting…”

Conclusions

Perceived consequences appeared to depend on provider type. However, informants
from all provider categories cautioned that this policy decision
would have a significant impact on the health status of some Ontarians.
Further research is warranted to explore the long-term effects of this policy
decision.

For example, the interests of individuals who are no longer eligible
for services may not be well served by such a policy change. Consider
a client who is between the ages of 20 and 64 years, self-employed and
without extended health benefits, the primary caregiver for elderly parents
with osteoarthritis in the lower spine and no longer eligible for OHIP-funded
PT services. This person does not fulfill the eligibility criteria for
PT, and if such services in the community are required, she or he will
need to access other, publicly funded settings or decide to allocate personal
resources to obtain PT. With some restorative PT services, this individual
may be able to maintain mobility and function. Without such services,
it could be argued that she or he might experience functional decline
earlier than expected.

Selected Tables from the Publication (with interpretation)

Table 1 lists the six open-ended questions and structured probes used in
the interviews with key informants.

Table 1. Semi-structured interview guide.

As you may know, the delisting of Schedule 5/OHIP clinics is occurring
on March 31, 2005. How do you anticipate your practice will be affected with
the delisting of Schedule 5/OHIP?

Have you or your facility taken any measure to prepare for the change?

In your opinion, what will be the impact of delisting on clients? Which
group of clients will be mostly affected? (Prompt: For example, will
clients and third-party insurers be required to assume a larger proportion
of funding for PT services?)

In your opinion, will there be a resulting impact on (1) inpatient length
of stay in hospitals, (2) outpatient hospital PT programs, (3) long-term
care facilities, (4) physical therapist under contract with CCAC, (5) private
practice and (6) population health?

From your perspective, how will funds previously allocated be redistributed?

Do you have any other comments/opinions regarding the delisting of Schedule
5/OHIP clinics?